Training is designed to target working memory, attentional systems, and processing speed. Procedures are designed to increase in difficulty as the participant improves. Training repetitively works various systems with adaptive activities that are delivered through direct personal interaction. Depending on the client’s initial assessment, training may also target secondary skills including auditory and visual processing, long-term memory, and logic and reasoning.
- Working Memory – Dopaminergic systems underlay working memory. Deficits in this system are believed to contribute to the core pathology of addiction. Weak working memory also appears in individuals with alcohol use disorder, attention deficit, and children with dysfunctional affective regulation. Developing the working memory, particularly with activities that utilize the dorsolateral prefrontal cortex regions attenuates the interfering effects of suggestive stimuli that can lead to cravings, use, and relapse. Moreover, stimulating bilateral DLPFC during working memory training has demonstrated enhanced impulsivity control and reduced delay discounting in individuals with SUD.
- Attention – Substance use disorders often present with numerous cognitive impairments, including impairments to attention. Deficient attention is a predictor of poor treatment outcomes and adherence to therapy-as-usual protocols. Cognitive skills training stimulates the brain’s inherent neuroplastic capacities, thereby leading to clinically significant improvements in both “bottom-up” and “top-down” processes (i.e., attention, perception, and cognitive control).
- Processing Speed – Neuroplastic processes can be associated deliberately with learning for therapeutic purposes. Cognitive training focuses on identifying those representational systems that are impaired and the underlying critical cognitions. Systems thus identified are trained to improve the speed and accuracy of desired task processing and distributed neural responses. As speed and accuracy improve, so does community functioning.
Most cognitive training clinical research to date has been limited to considering the impact of enhanced working memory, with some studies also considering the beneficial results from improved attention and processing speed. However, TransformED understands that the effect of therapy and rehabilitation should extend beyond successful clinical outcomes. After the SUD treatment or trauma recovery, the individual needs to become a productive, functioning member of the broader community, gain and maintain meaningful and substantive employment, perhaps acquire further training or higher education, and enter into fulfilling relationships.
TransformED therefore goes beyond cognitive training which only targets working memory, attention, and processing speed. While stimulating the areas of the brain associated with these primary skills has been shown to be a useful adjunct for TAU protocols, life after rehab or treatment will significantly benefit from enhanced secondary cognitive skills:
- Long-Term Memory – Long-term memory is essential to the performance of a variety life-skill tasks. Cognitive control deficits caused by SUD, trauma, or neurodegeneration can limit an individual’s ability to apply mnemonic or other memory strategies consistently. Training for long-term memory can significantly improve both the individual’s ability to store and to recall information.
- Visual Processing – Visual processing involves both visual speed of processing and long-term storage of mental images. Clinical research indicates that improvements in visual processing through cognitive training also leads to increases in instrumental activities of daily living and with working memory gains.
- Auditory Processing – Auditory processing involves auditory attention efficiency and long-term storage of auditory information. Recent studies indicate that cognitive training targeting of auditory processing may enhance the efficiency of an individual’s attention allocation through neuroplastic change. As with visual processing, the training of auditory processing has been clinically shown to improve cognition with the transfer of gains to functional tasks.
- Logic & Reasoning – Cognitive training explicitly targeting higher order cognition (HOC) can positively affect processing speed and related neural activity within the prefrontal cortex. Also, HOC training equips individuals with improved cognitive controls, attention strategies, integrative reasoning, and innovation. Studies provide evidence that HOC training may produce general increases in prefrontal cortex functioning and resource availability, leading to broad-spectrum neurocognitive function and executive function increases.